Year II of this grant will provide additional data and research on 200 candidates sitting for a Specialty Certification in Emergency Medicine. The data will provide a basis for comparative analyses of statistical methods employed to evaluate this new Criterion-Referenced Medical Specialty Certification Examination. A conceptual model of the psychometric properties of Clinical Competence was formulated during Year I using Field Test Data on the performance of four groups with known differences in competence to deliver health care. This model will be re-evaluated and extended using the data collected during this contract year. Since all conventional test formats employed for licensing and specialty certification are represented in this certification examination, the reliability and construct validity of these five formats can be compared and evaluated in a criterion-referenced test strategy. In addition, test development, scoring and psychometric evaluation methodologies will be evaluated and preferred methods indentified for any Criterion-Referenced Medical Examination. Recommendations regarding the use of Criterion-Referenced Medical Examinations for purposes of licensing and certification will be made. A conceptual and procedural model for the development, scoring and evaluation of Criterion-Referenced Medical Examinations will be documented.